Why One80 PT Doesn’t Use McKenzie, Maitland, or Protocol-Based Manual Therapy

Respecting the History — Challenging the Limitations

Robin McKenzie and Geoffrey Maitland were visionaries in their time. In an era when back pain was managed almost entirely with bed rest, their movement-based frameworks represented a meaningful step forward. We don’t dismiss that contribution.

What we do challenge is the clinical reality that these frameworks, developed in the 1950s through 1980s — are still being applied largely unchanged in clinics across the country, despite four decades of research that has clarified both what works and what doesn’t. More importantly, both systems share a fundamental limitation: they still don’t look for, or address, the root cause of pain.

The McKenzie Method: What the Evidence Actually Shows

The McKenzie Method (formally called Mechanical Diagnosis and Therapy, or MDT) uses repeated movements and patient education to identify a ‘directional preference’ (a direction of movement that reduces symptoms) and then uses that movement as the primary treatment.

A 2023 Cochrane systematic review on McKenzie for subacute and non-specific low back pain — representing the gold standard of evidence synthesis — found that based on low- to very low-certainty evidence, treatment effects for pain and disability were not clinically important. The authors concluded that the McKenzie method is not an effective treatment for subacute non-specific low back pain.

📚 Cochrane 2023 (Almeida et al.): McKenzie method for subacute NSLBP — treatment effects not clinically important; low to very low certainty evidence.

A 2024 systematic review found low-certainty evidence that McKenzie produced short-term pain reduction in chronic LBP patients with directional preference — a highly selected subgroup. Even the most favorable interpretation of the evidence is: short-term, modest, low-certainty benefit in a subset of patients.

📚 Journal of Manual & Manipulative Therapy, Oct 2024: Low-certainty evidence for McKenzie in chronic LBP with directional preference — short-term pain benefit only.

The deeper issue is conceptual. Identifying a ‘directional preference’ tells you which direction of movement currently hurts less. It tells you nothing about why the system is dysfunctional, which muscles aren’t working, or what structural compensation is generating the pain. It finds the symptom-modifying movement, not the cause.

Maitland and Joint Mobilization: Useful Tool, Incomplete System

Maitland’s approach uses graded joint oscillations and mobilizations to improve mobility and reduce pain. It is technically skillful and has a legitimate evidence base for improving range of motion and providing short-term pain relief — particularly in the cervical and lumbar spine.

The limitation is the same: joint mobilization addresses the joint, not the reason the joint is restricted. Joints become restricted because the muscles controlling them are not functioning correctly. Mobilize the joint, and it moves better temporarily. If the dysfunction causing the restriction isn’t addressed, the restriction returns, often within hours of treatment.

We have seen countless patients who have received months of Maitland-style mobilization for stiff, painful joints, and who remain stiff, painful, and confused about why they aren’t getting better. The technique is being applied correctly. But, the wrong target is being treated.

The Protocol Problem

Beyond McKenzie and Maitland specifically, there is a broader issue with protocol-based manual therapy: it treats the diagnosis, not the patient. A protocol for ‘lumbar disc herniation at L4-L5’ looks largely the same whether the patient is a 22-year-old athlete or a 62-year-old office worker — because it’s built around a diagnosis rather than the individual’s specific presentation and needs.

The One80 System requires a fresh evaluation of every patient at every visit. The neuromuscular assessment is individualized — it identifies the specific muscles that aren’t firing causing their specific movement patterns and compensation strategies. No two One80 treatment sessions look exactly alike, because no two patients have the same presentation.

What Critical Thinking Looks Like

Robin McKenzie asked: what direction of movement reduces this patient’s pain? That was progress. Geoffrey Maitland asked: which joints are restricted and how can I mobilize them? That was also progress.

The One80 System asks a different question: which muscles have become “turned off” (inhibited), and what muscles have been compensating as a result? That’s the most important question, because it identifies the root cause of dysfunction rather than the movement or structure that has broken down as a consequence of it.

FAQs

My therapist is McKenzie-certified. Does that mean they’re not good?

Not at all. McKenzie certification represents a significant investment in clinical training and a genuine commitment to systematic evaluation. Their work has just taken them down the wrong road, assessing and treating symptoms.

Does One80 ever use joint mobilization?

Yes, selectively. Joint mobilization has a legitimate role in restoring range of motion if there is a large loss of passive range of motion. Mobilization would be a starting point as part of the comprehensive treatment, with the One80 System being the finishing point.